Provider Demographics
NPI:1568033074
Name:REESE, TIFFANY CRYSTAL (MS, LPC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CRYSTAL
Last Name:REESE
Suffix:
Gender:
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 GARDNER RD STE 1500
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5702
Mailing Address - Country:US
Mailing Address - Phone:843-284-6423
Mailing Address - Fax:
Practice Address - Street 1:1052 GARDNER RD STE 1500
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5702
Practice Address - Country:US
Practice Address - Phone:843-284-6423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10616101YP2500X
SC8347101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1760596480Medicaid